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Simply Level Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Simply Level Platinum (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Simply Level Platinum (HMO C-SNP) in 2026, please refer to our full plan details page.
Simply Level Platinum (HMO C-SNP) is a HMO C-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward, Palm Beach. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Simply Level Platinum (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Simply Level Platinum (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Simply Level Platinum (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Simply Level Platinum (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $164.90. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3450.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Simply Level Platinum (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries enjoy no copays for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Supplemental Drugs) prescriptions filled at preferred pharmacies, standard pharmacies, or through standard mail order. This makes managing everyday medications highly affordable with zero out-of-pocket costs for these essential tiers. For higher-tier medications, Tier 3 (Preferred Brand) drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies. Tier 4 (Non-Preferred Drugs) carry a $95 copay at preferred pharmacies and standard mail order, or a $100 copay at standard pharmacies for a one-month fill. Specialty drugs in Tier 5 require a 33% coinsurance across all pharmacy options, ensuring clear cost-sharing for complex medical needs.
Additional Benefits
The Simply Level Platinum (HMO C-SNP) plan offers robust healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and routine lab tests. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for days six through 90, with no coinsurance required. Specialist visits, mental health sessions, and physical therapies are also highly affordable, requiring only a $20 copay and no coinsurance. This plan also features excellent supplemental benefits, including no copay and no coinsurance for routine dental care up to a $1,500 annual limit, alongside a $225 annual allowance for eyewear with no deductible. Additionally, members benefit from no copay on routine hearing exams and up to $1,000 yearly for prescription hearing aids. Other valuable perks include up to 24 one-way transportation trips per year with no copay and a $50 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Simply Level Platinum (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Simply Level Platinum (HMO C-SNP) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital copays range from no copay to $200, while observation services cost a $200 copay per stay and outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Ambulance and Transportation Services See details
Simply Level Platinum (HMO C-SNP) covers ground ambulance services with a $250 copay plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under Simply Level Platinum (HMO C-SNP) with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services are covered with a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum plan benefit limit of $100,000.
Primary Care See details
Primary care services are covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for primary care visits, telehealth, and routine podiatry, while chiropractic services are not covered. Specialist visits, mental health, psychiatric, opioid treatment, and physical, occupational, and speech therapies are covered with a $20 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance for covered services, which include kidney disease education, fitness benefits, and select screenings. However, several sub-services are not covered, including annual physical exams, in-home safety assessments, medical nutrition therapy, weight management programs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, and in-home support.
Hearing Services See details
Simply Level Platinum (HMO C-SNP) offers partially covered hearing services with no copay and no coinsurance for exams, fittings, and up to two prescription hearing aids with a $1,000 annual limit. However, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Simply Level Platinum (HMO C-SNP) vision services are partially covered with no copay, no coinsurance, and no deductible for one annual routine eye exam and up to $225 per year for contacts or eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Simply Level Platinum (HMO C-SNP) provides partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $1,500. Covered benefits include preventive care, restorative services, and oral surgery, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Simply Level Platinum (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Simply Level Platinum (HMO C-SNP) covers medical equipment, featuring durable medical equipment with no copay and 0% to 20% coinsurance, alongside prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Simply Level Platinum (HMO C-SNP) covers diagnostic and radiological services with no coinsurance, although prior authorization and referrals are required. There is no copay for lab services, outpatient X-rays, or diagnostic and therapeutic radiological services, while diagnostic procedures and tests carry a copay of $0 to $200.
Home Health Services See details
Home Health Services are fully covered by Simply Level Platinum (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Simply Level Platinum (HMO C-SNP) plan, including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Simply Level Platinum (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay requirement, though prior authorization and referrals are required. There is no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Simply Level Platinum (HMO C-SNP) offers partial coverage for other services, including over-the-counter (OTC) items up to $50 per month and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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